Method of applying hemostatic or tissue healing agent to wet surfaces

ABSTRACT

A device for applying a tissue healing agent includes an insertion member extending longitudinally from a proximal end to a distal end and including a channel extending therethrough, a delivery element including a first surface and a second surface opposing one another, the delivery element movable between a closed configuration, in which the delivery element is compressed to be received within the channel, and an open configuration, in which the delivery element is substantially planar, and a first tissue healing agent formed in a sheet configuration and disposed on the first surface of the delivery element.

PRIORITY CLAIM

This present application is a Continuation of U.S. patent applicationSer. No. 15/280,345 filed Sep. 29, 2016, which claims priority to U.S.Provisional Patent Application Ser. No. 62/238,321 filed Oct. 7, 2015;the disclosure of which is incorporated herewith by reference.

BACKGROUND

To treat wounds, ulcer beds, perforations and surgical bleeds,physicians may apply materials such as, for example, gels, particulates,sheets, tissue scaffolds or polymers, to wet tissue surfaces. With theincreasing use of tissue resection procedures, there is a clinical needto provide methods to manage complications, including bleeding, defectbeds and perforations, and promote healing. For example, a tissuehealing agent may need to be applied to achieve hemostasis at an activebleed site where the source can be approximately identified for, forexample, post resection defects, ulcer defects or tumor bleeds.Currently, bleeds and/or tissue defects may be treated by delivering agel or power like substance through an existing or modified endoscopiccatheter. However, gel material may not naturally sufficiently adhere towet tissue and may drip away from its intended site. In some cases, thedelivery of powder material may be wide-spread and somewhatuncontrolled. In addition, there is no common method for applying ordelivering tissue and/or polymer sheets to tissue.

SUMMARY

The present disclosure relates to a device for applying a tissue healingagent, comprising an insertion member extending longitudinally from aproximal end to a distal end and including a channel extendingtherethrough, a delivery element including a first surface and a secondsurface opposing one another, the delivery element movable between aclosed configuration, in which the delivery element is compressed to bereceived within the channel, and an open configuration, in which thedelivery element is substantially planar, and a first tissue healingagent formed in a sheet configuration and disposed on the first surfaceof the delivery element.

In an embodiment, the delivery element may be biased toward the openconfiguration and is constrained in the closed configuration via aninterior surface of the channel.

In an embodiment, the delivery element, in the closed configuration, maybe rolled upon itself to be received within the channel.

In an embodiment, a perimeter of the delivery element may include acurvature at a proximal end thereof so that, when the delivery elementis moved proximally toward the insertion member, in the openconfiguration, contact between the proximal end of the delivery elementand the distal end of the insertion member urges the delivery elementtoward the closed configuration.

In an embodiment, the device may further comprise a control memberattached to the delivery element for moving the delivery element betweenthe open and the closed configurations.

In an embodiment, the delivery element may be moved between the open andclosed configurations by rotating the control member about alongitudinal axis thereof.

In an embodiment, the tissue healing agent may have adhesive properties.

In an embodiment, the tissue healing agent may include at least one of asteroid, a polymer, a polyglycolic acid, a fibrin glue and a tissue cellmatrix sheet.

In an embodiment, the device may further comprise a release mechanismfor releasing the first tissue healing agent from the first surface ofthe delivery element.

In an embodiment, the release mechanism may include an element slidablealong the first surface between the first surface and the first tissuehealing agent.

In an embodiment, the release mechanism may include an elementextendable away from the first surface to release the first tissuehealing agent therefrom.

In an embodiment, the device may further comprise a second tissuehealing agent formed in a sheet configuration and disposed on the secondsurface of the delivery element.

The present disclosure also relates to a device for applying a tissuehealing agent, comprising an insertion member extending longitudinallyfrom a proximal end to a distal end and including a channel extendingtherethrough, a delivery element including a first surface and a secondsurface opposing one another, the delivery element movable between aclosed configuration, in which the delivery element is compressed to bereceived within the channel, and an open configuration, in which thedelivery element is substantially planar, a control member connected tothe delivery element and extending proximally therefrom to move thedelivery element between the open and closed configurations, a tissuehealing agent formed in a sheet configuration and disposed on the firstsurface of the delivery element, and a release mechanism movable coupledto the delivery element for releasing the tissue healing agenttherefrom.

In an embodiment, the release mechanism may include an element slidablealong the first surface between the first surface and the first tissuehealing agent.

In an embodiment, the release mechanism may include an elementextendable away from the first surface to release the first tissuehealing agent therefrom.

The present disclosure also relates to a method for applying a tissuehealing agent to a target tissue, comprising inserting an insertionmember into a living body to a target tissue to be treated, theinsertion member extending longitudinally from a proximal end to adistal end and including a channel extending therethrough, a deliveryelement housed in the insertion member in a closed configuration inwhich the delivery element is compressed, moving the delivery elementdistally relative to the insertion member to an open configuration inwhich the delivery element expands to be substantially planar, thedelivery element including first and second opposing surfaces, the firstsurface including a tissue healing agent formed in a sheet configurationand disposed thereon, and pressing the tissue healing against the targettissue to be treated.

BRIEF DESCRIPTION

FIG. 1 shows a partially cross-sectional view of a device according toan exemplary embodiment of the present disclosure;

FIG. 2 shows a cross-sectional view of a delivery element of the deviceof FIG. 1 , along a line A-A;

FIG. 3 shows a cross-sectional view of a delivery element of the deviceof FIG. 1 , according to an alternate embodiment of the presentdisclosure;

FIG. 4 shows a partially cross-sectional view of a device according toanother exemplary embodiment of the present disclosure, in an openconfiguration;

FIG. 5 shows a partially cross-sectional view of the device of FIG. 4 ,in a closed configuration;

FIG. 6 shows a cross-sectional view of a device according to yet anotherexemplary embodiment of the present disclosure;

FIG. 7 shows a cross-sectional view of a device according to analternate embodiment of the present disclosure; and

FIG. 8 shows a cross-sectional view of a device according to anotherexemplary embodiment of the present disclosure.

DETAILED DESCRIPTION

The present disclosure may be further understood with reference to theappended drawings and the following description, wherein like elementsare referred to with the same reference numerals. The present disclosurerelates to devices and methods for applying a tissue healing agentand/or hemostatic agent to tissue and, in particular, relates toapplying a tissue healing and/or hemostatic agent during an endoscopicprocedure. Exemplary embodiments of the present disclosure describe adevice including a delivery element on which a tissue healing agent maybe disposed. The delivery element may be, for example, a flexiblepaddle-shaped element movable between a closed configuration, in whichthe delivery element is rolled or folded so that the delivery element isinsertable through, for example, an insertion catheter, and an openconfiguration, in which the flexible paddle is unrolled or unfolded sothat the tissue healing agent may be applied to, for example, tissuealong a gastrointestinal (GI) wall. It will be understood by those ofskill in the art that the term “tissue healing agent”, as used hereinalso includes a hemostatic agent. It should be noted that the terms“proximal” and “distal”, as used herein, are intended to refer to adirection toward (proximal) and away from (distal) a user of the device(e.g., physician).

As shown in FIGS. 1 and 2 , a device 100 comprises a flexible deliveryelement 102 on which a tissue healing agent 110 is disposed in a sheetconfiguration. The delivery element 102 is passed through an insertionmember 104 such as, for example, an endoscopic catheter, via a controlmember 116 which moves the delivery element 102 longitudinally relativeto the insertion member 104. The delivery element 102 may, in an openconfiguration, be expanded to expose a substantially planar or curvedelement that is sufficiently flexible to be moved between a closedconfiguration and an open configuration and which has sufficientflexibility to permit it to conform to a shape of tissue against whichit is pressed. In the closed configuration, the delivery element 102 isrolled, folded or otherwise compressed (e.g., reduced in size and/ordiameter) so that the delivery element 102 is sized and shaped to bepassed through a channel 112 of the insertion member 104. In the openconfiguration, the delivery element 102 is unrolled, unfolded orotherwise radially expanded (e.g., to a configuration in which a radialextent of the delivery element is greater than an inner diameter of thechannel 112). For example, the delivery element 102 may be biased towardthe open configuration so that, when the delivery element 102 isextended longitudinally beyond the distal end of the channel 112, thedelivery element 102 is freed from the constraint of the inner surfaceof the channel 112 and reverts under its natural bias to the openconfiguration. As those skilled in the art will understand, the deliveryelement may, in the open configuration be substantially planar or curvedalong a shape selected to correspond to a shape of a surface of thetissue to be treated to deliver the tissue healing agent 110 to targettissue such as, for example, a tissue surrounding and/or including atissue defect, perforation or other bleed.

The insertion member 104 extends longitudinally from a proximal end (notshown) to a distal end 118 and includes the channel 112 extendinglongitudinally therethrough. In one example, the insertion member 104may be a flexible endoscopic catheter. The insertion member 104 may be,however, any element through which the delivery element 102 may beinserted to the site of target tissue to be treated and is preferablysufficiently flexible to be inserted to sites in the body which may beaccessed along a tortuous path such as through a natural body lumenaccessed via a natural bodily orifice. An exemplary insertion member 104is sized and shaped to be inserted through, for example, a working achannel of an endoscope.

The delivery element 102 may, for example, be shaped substantiallysimilarly to a paddle including first and second opposing, generallyplanar or curved surfaces 106, 108. The delivery element 102 issufficiently flexible such that the delivery element 102 is movablebetween the closed configuration and the biased open configuration. Thedelivery element 102 may, for example, be biased toward the openconfiguration and maintained in the closed configuration by an interiorsurface of 114 of the channel 112 of the insertion member 104. Once thedelivery element 102 is moved distally past a distal end 118 of theinsertion member 104 via the control member 116, however, the deliveryelement 102 is permitted to revert under its natural bias to the openconfiguration. In the open configuration, the delivery element 102remains substantially flexible so that the tissue healing agent 110,which is disposed along one or both of the surfaces 106, 108 thereof ina sheet configuration, may be pressed flush against a tissue surface tobe treated. Since the delivery element 102 has some flexibility, thedelivery element 102 is capable of contouring to a surface of a tissuewall such as, for example, a surface of the GI tract, similarly to anendoscopic snare or retrieval net which contours to a gastric wallsurface.

In one exemplary embodiment, the delivery element 102 may, in the openconfiguration, have a substantially rounded shape—e.g., a perimeter ofthe delivery element 102 or a perimeter of a portion of the deliveryelement may be curved. In particular, proximal edges 126 may be curvedso that, when it is desired to remove the delivery element 102 from theliving body, the delivery element 102 may be smoothly drawn proximallyinto the insertion member 104 with the curved proximal edges 126contacting the distal end 118 of the insertion member 104 urging thedelivery element to fold on itself to return from the open configurationto the closed configuration. As the delivery element 102 is drawnfurther proximally relative to the insertion member 104, the deliveryelement 102 is received within the insertion member 104 and againconstrained in the closed configuration therewithin. As would beunderstood by those skilled in the art, the delivery element 102 may bestructured so that, in the open configuration it assumes any of avariety of shapes and/or sizes for delivering a tissue healing agent 110to tissue surfaces of a corresponding variety of shapes and sizes.

The control member 116 extends from a distal end 120 connected to aproximal end 122 of the delivery element 102 to a proximal end (notshown) which extends proximally of a proximal end of the insertionmember 104 to be accessible to a user of the device 100. Thus, movingthe control member 116 longitudinally relative to the insertion member104 moves the delivery element between the open and closedconfigurations. The control member 116 may be connected to the deliveryelement 102 to provide degrees of freedom of movement to the deliveryelement 102 relative to the control member 116.

The tissue healing agent 110 may be formed in a sheet so that, whendisposed along either or both of the first and second surfaces 106, 108of the delivery element 102, the tissue healing agent 110 substantiallycovers one or both of the first and second surfaces. The tissue healingagent 110, however, is also preferably sufficiently flexible so that thetissue healing agent 110 during expansion and compression (e.g.,rolling) of the delivery element between the open and closedconfigurations, the tissue healing agent remains in place on thecorresponding surface(s) of the delivery element 102. The tissue healingagent 110 may be, for example, a steroid, desiccant, or polymer formedin a sheet configuration to promote tissue healing/hemostasis of atissue defect. The tissue healing agent 10 may be resorbable such thatthe tissue healing agent 110 dissolves within the body after apredetermined amount of time. Examples of tissue healing agents 110include polyglycolic acid, fibrin glue, and tissue cell matrix sheets.

In one embodiment, the adhesive properties of the tissue healing agent110 adheres to tissue with which it is brought into contact and is drawnoff of the delivery element 102 as the delivery element 102 is movedaway from this tissue. In another embodiment, as shown in FIG. 2 , thedevice 100 further comprises a release element 124 for releasing thetissue healing agent 110 from the delivery element 102. For example, therelease element 124 of this embodiment lifts an edge of the tissuehealing agent 110 away from the delivery element 102 as the tissuehealing agent 110 is pressed against the target tissue. In anotherexample, the release mechanism is slidable along the surface 106, 108 onwhich the tissue healing agent 110 is disposed, between the proximal end122 and a distal end 130 thereof, between the first surface 106 and thetissue healing agent 110 disposed thereon to release the tissue healingagent 110. In another example, as shown in FIG. 3 , a release element124′ extends along a portion of a length and/or width of a first surface106′ to which a tissue healing agent 110′ is disposed so that actuatingthe release element 124′ moves the release element 124′ away from thefirst surface 106′ of a delivery element 102′ to release the tissuehealing agent 110′. Although FIG. 3 , shows the tissue healing agent110′ disposed on the first surface 106′, a tissue healing agent may alsobe disposed on a second surface 108′ so that the second surface 108′ mayalso include a release element 124′.

The release mechanisms 124 (and the release mechanism 124′) may beactuated via an actuator which extends proximally of a proximal end ofthe insertion member 104 to be accessible to the user of the device 100(i.e., which remains outside the body when the delivery element isinserted into the body to a target tissue site). The release mechanism124 may be connected to the actuator via, for example, a control wire128 which extends from the release mechanism 124 to the actuator alongor within the control member 116. The control wire 128 may belongitudinally movable relative to the control member 116 to control amovement of the release mechanism 124 relative to the delivery element102.

It is noted that although the exemplary embodiment shows and/ordescribes the tissue healing agent 110 as disposed on the first surface106, a second sheet of the tissue healing agent 110 may also be disposedon the second surface. In an embodiment in which a second sheet of thetissue healing agent is disposed on the second surface 108 of thedelivery element 102, the device 100 may comprise a second releasemechanism for releasing the second sheet of the tissue healing agent 110from the second surface 108 of the delivery element 110.

According to an exemplary method using the device 100, the insertionmember 104, with the delivery element 102 housed therein in the closedconfiguration, is inserted into a living body to the target tissue to betreated via, for example, a working channel of an endoscope insertedthrough, for example, a body lumen accessed via a naturally occurringbodily orifice. Once the distal end 118 has been positioned proximatethe target tissue, the delivery element 102 may be moved to the openconfiguration via the control member 116. As the delivery element 102 ismoved distally past the distal end 118 of the insertion member 104, thedelivery element 102 reverts to the biased open configuration in whichthe delivery element is unrolled or expanded such that the first andsecond surfaces 106, 108 are substantially planar or curved toapproximate a shape of a tissue surface against which it is pressed. Thefirst surface 106, which has the tissue healing agent 110 disposedthereon in a sheet configuration, is then pressed against the targettissue so that the tissue healing agent 110 is applied to the targettissue.

As discussed above, the flexibility of the delivery element 102 permitsthe delivery element 102 to conform to a shape of a surface of thetarget tissue to aid in application of the tissue healing agent 110therein. Where the tissue healing agent 110 is not sufficiently adhesiveto disengage from the delivery element 102 upon pressing of the tissuehealing agent 110 against the target tissue, a release mechanism 124 maybe actuated to release the tissue healing agent 110 from the firstsurface 106 and onto the target tissue. If the device 100 includes asecond sheet of the tissue healing agent 110 on the second surface 108,the second surface 108, with the tissue healing agent 110 disposedthereon, the above-described process may be repeated by pressing thesecond surface 108 against a second portion of tissue to be treated toapply the tissue healing agent 110 thereon. Similarly, a releasemechanism may be actuated to release the second sheet of the tissuehealing agent 110 from the second surface 108.

When it is desired to remove the device 100 from the living body, thedevice 100 is moved to the closed configuration by drawing the deliveryelement 102 proximally into the insertion member 104. Curved proximaledges 126 of the delivery element 102 contact the distal end 118 of theinsertion member 104 to urge the delivery element 102 into the closedconfiguration. Once the delivery element 102 is drawn into the channel112 of the insertion member 104 and is in the closed configuration, thedevice 100 may be removed from the body.

As shown in FIGS. 4 and 5 , a device 200 according to another exemplaryembodiment of the present disclosure may be substantially similar to thedevice 100, comprising a delivery element 202 slidably received within achannel 212 of an insertion member 204. Similarly to the device 100, atissue healing agent 210 is disposed on either or both of the first andsecond surfaces 206, 208 of the delivery element 202. The deliveryelement 202, however, is movable between an open configuration, as shownin FIG. 4 , and closed configuration, as shown in FIG. 5 , via rotationof a control member 216. The delivery element 202 is connected to thecontrol member 216 along a longitudinal side 226 thereof so that, whenthe control member 216 is rotated in a first direction about alongitudinal axis thereof, the delivery element 202 is wound or rolledabout a distal portion of the control member 216 in the closedconfiguration. When the control member 216 is rotated in a seconddirection about the longitudinal axis, the delivery element 202 isunrolled to an open configuration to apply the tissue healing agent 210to a target tissue.

Similarly to the delivery element 102, the delivery element 202 hassubstantially planar or curved first and second surfaces 206, 208, whenthe delivery element 202 is in the open configuration. The deliveryelement 202 is flexible so that, when the control member 216, which isconnected to the delivery element 202 to control movement thereof, isrotated about the longitudinal axis in the first direction, the deliveryelement 202 is rolled about the distal portion of the control member 216to which the delivery element 202 is connected. Thus, the deliveryelement 202 may be housed within the channel 212 of the insertion member204 during insertion and removal of the device 200 into a living body tothe target tissue to be treated. In addition, the flexibility of thedelivery element 202 allows the delivery element 202 to conform to ashape of a tissue surface against which it is pressed.

The tissue healing agent 210 may be substantially similar to the tissuehealing agent 110. In particular, the tissue healing agent 210 isdisposed on one of the first and second surfaces 206, 208 in a sheetconfiguration so that, when the delivery element 202 is rolled into theclosed configuration, the tissue healing agent 210 is similarly rolledthereinto. Where the tissue healing agent 210 is disposed on only one ofthe first and second surface 206, 208, the tissue healing agent 210 maybe on the first surface 206, which is positioned so that, when rolledinto the closed configuration, faces outward—toward the target tissue.

In use, the insertion member 204 is inserted to the target tissue, withthe delivery element 202 therein in the closed configuration, via, forexample, a working channel of an endoscope. Once a distal end 218 of theinsertion member 204 is positioned proximate the target tissue, thedelivery element 202 is moved distally relative to the insertion member204 until a proximal end 222 of the delivery element 202 is distal thedistal end 218. The delivery element 202, in the closed configuration,is pressed against the target tissue and moved from the closedconfiguration to the open configuration. In particular, the controlmember 216 is rotated about the longitudinal axis thereof to unroll thedelivery element 202 against the target tissue to be treated. In oneembodiment, the adhesive properties of the tissue healing agent 210 maycause the sheet of the tissue healing agent 210 to be released from thedelivery element 202 as the tissue healing agent 210 is pressed againstthe target tissue. Alternatively, a release mechanism 224, may beactuated to release the tissue healing agent 210 from the deliveryelement 210. The release mechanism 224 may be substantially similar tothe release mechanism 124 described above in regard to device 100. Forexample, the release mechanism 224, as shown in broken line in FIG. 4 ,may cause an edge of the tissue healing agent 210 to lift away fromdelivery element 202. In another example, the release mechanism 224 mayinclude an element that is slidable across the first surface 206, onwhich the tissue healing agent 210 is disposed.

As shown in FIGS. 6 and 7 , a device 300 for applying a liquid or geltissue healing agent according to another exemplary embodiment of thepresent disclosure may comprise a delivery element 302 slidable throughan insertion member 304 to deliver the tissue healing agent to a targettissue. The insertion member 304 may be substantially similar to theinsertion members 104, 204 described above in regard to the device 100,200. The insertion member 304 is insertable through, for example, aworking channel to the target tissue. The delivery element 302 may be,for example, a brush including a shaft 306 and a distal portion 309including bristles 308 thereon. The bristles 308 may trap and hold thetissue healing agent therebetween when the bristles 308 is pre-soakedtherein. The brush 302 is then passed through the insertion member 304,distally beyond a distal end 318 thereof, until the bristled distalportion 309 reaches the target tissue to apply the tissue healing agentthereto. The bristled distal portion 309 may be straight relative to theshaft 306, as shown in FIG. 6 , or angled, as shown in FIG. 7 , so thatwhen extended distally from the insertion member 304, the bristles 308more easily contact a surface of the target tissue to apply the tissuehealing agent thereon. Additional tissue healing gent may be passedthrough the channel 312 and simply guided and applied via the distalportion 309 to the desired target area. The tissue healing agent may beapplied through, for example, a luer lock channel via a syringe or otherfluid delivery system (e.g., centrifugal pump).

As shown in FIG. 8 , a device 400 for delivering a tissue healing agentto a target tissue according to another exemplary embodiment of thepresent disclosure comprises a foam applicator 402 connected to a distalend 418 of a longitudinal member 404 via a hard cap 430. Thelongitudinal member 404 may be, for example, a catheter including adelivery lumen 412 extending longitudinally therethrough. The tissuehealing agent may have a substantially liquid or gel-like form so thatthe tissue healing agent may be passed through the delivery lumen 412 tothe foam applicator 402. The cap 430 connecting the foam applicator 402to the longitudinal member 404 may include one or more openings throughwhich the tissue healing agent may be passed to the foam applicator 402.

The device 400 may be inserted to the target tissue via a workingchannel of an endoscope. In a further embodiment, the device 400 mayfurther include an insertion member through which the device 400 may beinserted to the target tissue. The insertion member may act as aprotective outer lumen in which the foam applicator 402 is housed untilit reaches the target tissue.

Variations may be made in the structure and methodology of the presentdisclosure, without departing from the spirit and the scope of thedisclosure. Thus, it is intended that the present disclosure cover themodifications and variations of this disclosure that may be contemplatedby a person of skill in the art.

What is claimed is:
 1. A device for applying a tissue healing agent,comprising: an insertion member extending longitudinally from a proximalend to a distal end and including a channel extending therethrough; adelivery element including a first surface and a second surface opposingone another, the delivery element movable between a closedconfiguration, in which the delivery element is compressed to bereceived within the channel, and an open configuration, in which thedelivery element is substantially planar; a first tissue healing agentformed in a sheet configuration and disposed on the first surface of thedelivery element; a control member attached to the delivery element formoving the delivery element between the open and the closedconfigurations, wherein the delivery element is moved between the openand closed configurations by rotating the control member about alongitudinal axis thereof; and a release mechanism for releasing thefirst tissue healing agent from the first surface of the deliveryelement, including an element slidable along the first surface betweenthe first surface and the first tissue healing agent.
 2. The device ofclaim 1, wherein the delivery element is biased toward the openconfiguration and is constrained in the closed configuration via aninterior surface of the channel.
 3. The device of claim 1, wherein, inthe closed configuration, the delivery element is rolled upon itself tobe received within the channel.
 4. The device of claim 1, wherein aperimeter of the delivery element includes a curvature at a proximal endthereof so that, when the delivery element is moved proximally towardthe insertion member, in the open configuration, contact between theproximal end of the delivery element and the distal end of the insertionmember urges the delivery element toward the closed configuration. 5.The device of claim 1, wherein the tissue healing agent has adhesiveproperties.
 6. The device of claim 1, wherein the tissue healing agentincludes at least one of a steroid, a polymer, a polyglycolic acid, afibrin glue and a tissue cell matrix sheet.
 7. The device of claim 1,wherein the release mechanism includes an element extendable away fromthe first surface to release the first tissue healing agent therefrom.8. The device of claim 1, further comprising a second tissue healingagent formed in a sheet configuration and disposed on the second surfaceof the delivery element.
 9. A device for applying a tissue healingagent, comprising: an insertion member extending longitudinally from aproximal end to a distal end and including a channel extendingtherethrough; a delivery element including a first surface and a secondsurface opposing one another, the delivery element movable between aclosed configuration, in which the delivery element is compressed to bereceived within the channel, and an open configuration, in which thedelivery element is substantially planar; a control member connected tothe delivery element and extending proximally therefrom to move thedelivery element between the open and closed configurations; a firsttissue healing agent formed in a sheet configuration and disposed on thefirst surface of the delivery element; and a release mechanism movablecoupled to the delivery element for releasing the tissue healing agenttherefrom, including an element slidable along the first surface betweenthe first surface and the first tissue healing agent.
 10. The device ofclaim 9, wherein the release mechanism includes an element extendableaway from the first surface to release the first tissue healing agenttherefrom.